Introduction: Open defecation is the practice of defecating in fields, bushes, forests, open bodies of water, or other open spaces rather than using the toilet to defecate. It is common in developing countries. Most people who practice open defecation live in rural areas, but the number in urban areas is increasing. When it occurs in sparsely populated areas or forests it might not lead to grave consequences but it becomes a significant public health issue when it occurs in more densely populated areas, fields, urban parks, rivers and open trenches in close proximity to the living space of others or where other people can make contact with the faeces or soil contaminated with the faeces.
The reasons for open defecation are varied, and this activity can indeed be a voluntary or semi-voluntary choice, but in most cases it is due to the fact that toilets are not available or they are not clean, safe or they do not guarantee privacy. A preference for open defecation behavior may also be due to traditional cultural practices. Unfortunately, Nigeria is one of the countries with the highest number of people openly defecating (39 million).
Consequences of open defecation
In countries where open defecation is common, there is a high level of under-nutrition, child deaths; especially among children younger than five years of age and poverty. Open defecation maintains the vicious cycle of disease and poverty and is widely regarded as an affront to personal dignity. The health and personal safety impacts due to open defecation are principally the same as those from lack of sanitation. There are three identified direct pathways through which poor sanitation (and associated open defecation) may adversely affect nutritional outcomes in children: diarrhoeal diseases, malabsorption of nutrients, and worm infections.
Young children are vulnerable to ingesting feces of other people that lie around as a result of open defecation, because such children crawl on the ground and put things in their mouths without washing their hands. This can lead to different kinds of infection such as cholera, typhoid, hepatitis A, polio, diarrhea, worm infestation and others. Moreover, the rain can wash the faeces into bodies of surface water such as a stream or river or unprotected wells. When people drink water that has been mixed with other people’s faeces, the infections mentioned above especially diarhoeal diseases can also result from such. Meanwhile, diarrhea is the third commonest cause of death among children younger than five years of age in Sub-Saharan Africa.
Repeated infection with diarrhoeal diseases contributes to chronic under nutrition by reducing appetite and inhibiting intestinal absorption of nutrients. The little nutrients absorbed are also wasted in dealing with the infection instead of contributing to the growth. Apart from the chronic under-nutrition which manifests as short stature, the children are likely to suffer lower intellectual capacity. Under nutrition in turn increases susceptibility to infectious diseases, such as diarrhoea, thus perpetuating somewhat of a vicious circle.
Another result of ingestion of faecal bacteria apart from diarrheoal is a condition which causes malabsorption of nutrients. When nutrients are not well absorbed, it leads to under-nutrition and if prolonged, stunting in children.
Children and adults who walk barefooted can also step on the faeces and thereby get infected with hookworm or other worms which are transmitted through the soil. These worms cause malabsorption and compete with the person for nutrients that should have been used for blood formation and other functions in the body. This can also lead to under-nutrition and hence growth retardation in children.
A child’s height reflects her nutritional and health status within the first few years of life, including before birth. Children who are well nourished within the first 1000 days of life are likely to achieve their maximum height potential. Since height is an indicator of the development of bodies, brains and skills, most children who achieve their maximum height potential are likely to grow up to be more productive and live longer. Whereas those who suffer under-nutrition in childhood are likely to be less productive and more susceptible to diet related Non-communicable diseases in adulthood.
Many children are not able to survive the infection and under-nutrition, therefore they die. According to UNICEF, a child dies every 2.5 minutes as a result of open defecation. If the problems of open defecation are tackled properly, several advantages will result in the nation including reduction in hospital visits, school absenteeism and child deaths.
How to tackle the problem
Access to sanitation is critical for human development. There is enough evidence that connect open defecation to nutrition, health and development. The society at large should view the lack of toilets as unacceptable. Construction of toilets should not be seen as the government’s responsibility, but as a priority that individual households should take responsibility for. Each household should have at least one toilet. People should be motivated to see a toilet as fundamental to their social standing, status and well-being.
Policymakers in Nigeria should please invest into measures that improve access to Water, Sanitation and Hygiene (WASH) so that people who practice this habit because of lack of facilities can stop it. There should be several public toilets in strategic places so that people can defecate safely when they are not in their houses. There should be adequate water supply everywhere and the people should be well informed to inculcate hygienic practices.
Health education on the disadvantages especially the health problems associated with open defecation should become popular. There is a need for behavioral change in addition to the provision of toilets, because even if toilets are available, people still need to be convinced to desist from open defecation and use the toilets.